401k Plan data: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN plan

JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 401k Plan overview

Plan Name	JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN
Plan identification number	501

JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

JW POWERLINE, LLC has sponsored the creation of one or more 401k plans.

Company Name: JW POWERLINE, LLC

Employer identification number (EIN): 751921002

NAIC Classification: 221100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-04-01 PATRICIA BOURGEOIS 2021-12-21
501 2019-04-01 DINA RODRIGUEZ 2021-01-04
501 2018-04-01 DINA RODRIGUEZ 2019-12-26
501 2016-04-01 HEIDI HENRICHS
501 2016-04-01 DINA RODRIGUEZ 2019-02-06
501 2015-04-01 HEIDI HENRICHS
501 2014-04-01 JIM HEURTIN
501 2013-04-01 KYLE WATKINS
501 2012-04-01 JAMES F. WEBB

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2020-04-01	PATRICIA BOURGEOIS	2021-12-21
501	2019-04-01	DINA RODRIGUEZ	2021-01-04
501	2018-04-01	DINA RODRIGUEZ	2019-12-26
501	2016-04-01	HEIDI HENRICHS
501	2016-04-01	DINA RODRIGUEZ	2019-02-06
501	2015-04-01	HEIDI HENRICHS
501	2014-04-01	JIM HEURTIN
501	2013-04-01	KYLE WATKINS
501	2012-04-01	JAMES F. WEBB

Plan Statistics for JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN

401k plan membership statisitcs for JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN

Measure Date Value
2020: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year 2020-04-01 145
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 78
Number of retired or separated participants receiving benefits 2020-04-01 0
Number of other retired or separated participants entitled to future benefits 2020-04-01 0
Total of all active and inactive participants 2020-04-01 78
Number of employers contributing to the scheme 2020-04-01 0
2019: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year 2019-04-01 129
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 145
Number of retired or separated participants receiving benefits 2019-04-01 0
Number of other retired or separated participants entitled to future benefits 2019-04-01 0
Total of all active and inactive participants 2019-04-01 145
Number of employers contributing to the scheme 2019-04-01 0
2018: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-04-01 129
Total number of active participants reported on line 7a of the Form 5500 2018-04-01 129
Number of retired or separated participants receiving benefits 2018-04-01 0
Number of other retired or separated participants entitled to future benefits 2018-04-01 0
Total of all active and inactive participants 2018-04-01 129
Number of employers contributing to the scheme 2018-04-01 0
2016: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 269
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 190
Total of all active and inactive participants 2016-04-01 190
Number of retired or separated participants receiving benefits 2016-04-01 0
Number of other retired or separated participants entitled to future benefits 2016-04-01 0
Number of employers contributing to the scheme 2016-04-01 0
2015: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-04-01 219
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 269
Total of all active and inactive participants 2015-04-01 269
2014: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-04-01 184
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 219
Total of all active and inactive participants 2014-04-01 219
2013: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-04-01 156
Total number of active participants reported on line 7a of the Form 5500 2013-04-01 184
Number of retired or separated participants receiving benefits 2013-04-01 0
Number of other retired or separated participants entitled to future benefits 2013-04-01 0
Total of all active and inactive participants 2013-04-01 184
2012: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-04-01 101
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 154
Number of retired or separated participants receiving benefits 2012-04-01 2
Number of other retired or separated participants entitled to future benefits 2012-04-01 0
Total of all active and inactive participants 2012-04-01 156

Measure	Date	Value
2020: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year	2020-04-01	145
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	78
Number of retired or separated participants receiving benefits	2020-04-01	0
Number of other retired or separated participants entitled to future benefits	2020-04-01	0
Total of all active and inactive participants	2020-04-01	78
Number of employers contributing to the scheme	2020-04-01	0
2019: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year	2019-04-01	129
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	145
Number of retired or separated participants receiving benefits	2019-04-01	0
Number of other retired or separated participants entitled to future benefits	2019-04-01	0
Total of all active and inactive participants	2019-04-01	145
Number of employers contributing to the scheme	2019-04-01	0
2018: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-04-01	129
Total number of active participants reported on line 7a of the Form 5500	2018-04-01	129
Number of retired or separated participants receiving benefits	2018-04-01	0
Number of other retired or separated participants entitled to future benefits	2018-04-01	0
Total of all active and inactive participants	2018-04-01	129
Number of employers contributing to the scheme	2018-04-01	0
2016: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	269
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	190
Total of all active and inactive participants	2016-04-01	190
Number of retired or separated participants receiving benefits	2016-04-01	0
Number of other retired or separated participants entitled to future benefits	2016-04-01	0
Number of employers contributing to the scheme	2016-04-01	0
2015: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-04-01	219
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	269
Total of all active and inactive participants	2015-04-01	269
2014: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-04-01	184
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	219
Total of all active and inactive participants	2014-04-01	219
2013: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-04-01	156
Total number of active participants reported on line 7a of the Form 5500	2013-04-01	184
Number of retired or separated participants receiving benefits	2013-04-01	0
Number of other retired or separated participants entitled to future benefits	2013-04-01	0
Total of all active and inactive participants	2013-04-01	184
2012: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-04-01	101
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	154
Number of retired or separated participants receiving benefits	2012-04-01	2
Number of other retired or separated participants entitled to future benefits	2012-04-01	0
Total of all active and inactive participants	2012-04-01	156

Form 5500 Responses for JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN

2020: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2019: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2018: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2016: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Submission has been amended	Yes
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2015: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2014: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes
2013: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2013 form 5500 responses
2013-04-01	Type of plan entity	Single employer plan
2013-04-01	Submission has been amended	No
2013-04-01	This submission is the final filing	No
2013-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-04-01	Plan is a collectively bargained plan	No
2013-04-01	Plan funding arrangement – Insurance	Yes
2013-04-01	Plan benefit arrangement – Insurance	Yes
2012: JIM F WEBB INC. DBA JW POWERLINE HEALTH PLAN 2012 form 5500 responses
2012-04-01	Type of plan entity	Single employer plan
2012-04-01	First time form 5500 has been submitted	Yes
2012-04-01	Submission has been amended	No
2012-04-01	This submission is the final filing	No
2012-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-04-01	Plan is a collectively bargained plan	No
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

239386

Policy instance

Insurance contract or identification number	239386
Number of Individuals Covered	184
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $60,079
Total amount of fees paid to insurance company	USD $2,670
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,070,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $60,079
Amount paid for insurance broker fees	2670
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

239386

Policy instance

Insurance contract or identification number	239386
Number of Individuals Covered	340
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $87,348
Total amount of fees paid to insurance company	USD $1,845
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,192,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $87,348
Amount paid for insurance broker fees	1845
Additional information about fees paid to insurance broker	SPECIAL PROGRAMS
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

239386

Policy instance

Insurance contract or identification number	239386
Number of Individuals Covered	267
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $45,183
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $936,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $34,161
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	JW POWERLINE, LLC
Employer identification number (EIN):	751921002
NAIC Classification:	221100